Rotational coupling device for surgical instrument with flexible actuators

ABSTRACT

Rotational couplers for use with surgical devices that are actuated by semi-flexible actuators such as wires and the like. The couplers enable the actuators to apply various actuation motions to actuation features on the surgical device as well as other actuators to apply axial and rotational motions to the surgical device to manipulate the device into various orientations relative to an elongate shaft to which the device is movably attached.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of copending U.S. patentapplication Ser. No. 12/277,957, now U.S. Pat. No. 8,157,834, filed Nov.25, 2008, which is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

The present invention generally relates to methods and devices forcontrolling movement of a working end of a surgical device.

BACKGROUND

In laparoscopic surgical procedures, a small incision is made in thebody and an elongate shaft of a surgical device is inserted through theincision to position a distal end of the shaft at a surgical site. Inendoscopic procedures, the elongate shaft of a surgical device isinserted through a natural orifice, such as the mouth or anus, and isadvanced along a pathway to position a distal end of the device at asurgical site. Endoscopic procedures typically require the use of aflexible shaft to accommodate the tortuous pathway of the body lumen,whereas rigid shafts can be used in laparoscopic procedures. These toolscan be used to engage and/or treat tissue in a number of ways to achievea diagnostic or therapeutic effect.

Many current laparoscopic and endoscopic devices utilize articulatingeffectors to provide the user with more control over the orientation ofthe working end of the instrument. Integration of the controls forarticulating, as well as actuating, a working end of a laparoscopic orendoscopic device tend to be complicated by the size constraints of therelatively small pathway through which it is inserted. The controls foran endoscopic device are further complicated by the flexibility of theshaft. Generally, the control motions are all transferred through theshaft as longitudinal translations, which can interfere with theflexibility of the shaft. There is also a desire to lower the forcenecessary to articulate and/or actuate the working end to a level thatall or a great majority of surgeons can handle. One known solution tolower the force-to-fire is to use electrical motors. However, surgeonstypically prefer to experience feedback from the working end to assureproper operation of the end effector. The user-feedback effects are notsuitably realizable in present motor-driven devices.

U.S. Patent Application Publication No. U.S. 2008/0147113 A1 to RudolphH. Nobis et al., Ser. No. 11/610,803, filed Dec. 14, 2006, thedisclosure of which is herein incorporated by reference in its entiretydiscloses various manually articulated surgical instruments that may beactuated by manipulating one or more actuation wires that extend from ahandle through an elongate tube to an end effector operably coupled tothe distal end of the tube. Various embodiments of those devices employan end effector that may also be selectively rotated relative to alongitudinal axis of the device. When rotated, the actuation wire orwires also rotate to avoid malfunction thereof.

Accordingly, there remains a need for improved rotational couplingarrangement for surgical instruments that are actuated by flexible orsemi-flexible members such as wires and the like.

The foregoing discussion is intended only to illustrate some of theshortcomings present in the field of the invention at the time, andshould not be taken as a disavowal of claim scope.

BRIEF SUMMARY

Methods and devices are provided for controlling movement of a workingend of a surgical device. In one embodiment, a surgical device isprovided that has an elongate substantially hollow shaft that defines anelongate axis. An end effector may be operably coupled to a distal endof the elongate shaft for selective pivotal and rotational travelrelative thereto. The end effector may have at least one actuationfeature thereon that is actuatable upon application of axial actuationmotions thereto. An articulation actuator may operably interface withthe end effector for applying axial articulation motions thereto tocause the end effector to pivot relative to the distal end of theelongate shaft and selectively apply rotation motions thereto to causethe end effector to rotate relative to the distal end of the elongateshaft about the elongate axis. A first input actuator may be providedfor transferring axial actuation motions. Various embodiments furtherinclude a rotational coupling that comprises a driving coupler that ismovably supported within a portion of the elongate substantially hollowshaft and is also coupled to a distal end of the first input actuatorfor receiving the axial actuation motions therefrom. An idler couplermay be movably supported within a portion of the substantially elongatehollow shaft and may be rotatably coupled to the driving coupler forrotation relative thereto about the elongate axis. The idler coupler maybe further configured for axial travel with the driving coupler alongthe actuation axis. At least one second input actuator may be coupled tothe idler coupler and the actuation features on the end effector suchthat the second input actuator transfers the axial actuation motionsfrom the rotational coupling to at least one actuation feature of theend effector. A proximal end of a three-bar linkage may be coupled tothe distal end of the elongate shaft, and a distal end of the three-barlinkage may be coupled to an end effector. The end effector can be, forexample, a grasper, a biopsy probe, a snare loop, forceps, scissors, aneedle knife, a sphincterotome, etc. In use, the three-bar linkage isadapted to laterally articulate relative to a longitudinal axis of theelongate shaft to allow the end effector to be angularly orientedrelative to the elongate shaft.

In accordance with other embodiments of the present invention, there isprovided a surgical device that includes an elongate substantiallyhollow shaft that defines an elongate axis. An end effector is operablycoupled to a distal end of the elongate shaft for selective pivotal androtational travel relative thereto. The end effector may have at leastone actuation feature thereon that is actuatable upon application of atleast one axial actuation motion thereto. An articulation actuator mayoperably interface with the end effector to apply axial articulationmotions thereto to cause the end effector to pivot relative to thedistal end of the elongate shaft and to selectively apply rotationmotions thereto to cause the end effector to rotate relative to thedistal end of said elongate shaft about the elongate axis. A first inputactuator may extend from the handle assembly to transfer at least oneaxial actuation motion. The embodiments may further comprise arotational coupling that has a proximal tubular member that is rotatablysupported within the hollow elongate shaft and is coupled to the firstinput actuator for receiving at least one axial actuation motiontherefrom. A distal tubular member may be rotatably supported within thehollow elongate shaft and be coupled to the proximal tubular member foraxial travel therewith such that the distal tubular member can rotaterelative to the proximal tubular member. At least one second inputactuator may be coupled to the distal tubular member and the actuationfeatures on the end effector such that the second input actuatortransfers the at least one axial actuation motion applied thereto to atleast one actuation feature of the end effector.

In connection with other features of the present invention, there isprovided various rotational couplings for surgical devices that aremovably coupled to an elongate shaft wherein the surgical device has atleast one actuation feature thereon that is actuatable upon applicationof at least one actuation motion from an actuator and which surgicaldevice is articulatable and rotatable relative to the elongate shaftupon application of other actuation motions from another actuator.Various embodiments of the rotational coupling comprise a driver memberthat is coupled to the actuator for receiving at least one actuationmotion therefrom. An idler member may be rotatably coupled to the drivermember for selective rotation relative to the driver member about alongitudinal axis and is configured to axially move as a unit with thedriver member. The driver member and the idler member may movablysupport a portion of the other actuator therein. An output member may becoupled to the idler member and the surgical device for transferring theat least one actuation motion from the idler member to the surgicaldevice.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 is a side view of an end effector and portion of elongate shaftwith which various rotational coupling embodiments of the presentinvention may be employed;

FIG. 2 is a cross-sectional view of the end effector and elongate shaftof FIG. 1 with the end effector shown in an articulated position;

FIG. 2A is an enlarged cross-sectional view of a portion of the endeffector of FIG. 2;

FIG. 3 is a perspective view of a handle assembly embodiment that may beemployed in connection with various embodiments of the presentinvention;

FIG. 4 is an exploded assembly view of the handle assembly of FIG. 3;

FIG. 5 is a partial assembly view of a portion of the handle assembly ofFIGS. 3 and 4;

FIG. 6 is another partial assembly view of a portion of the handleassembly of FIGS. 3-5; and

FIG. 7 is a cross-sectional view of another end effector and elongateshaft employing another rotational coupling embodiment of the presentinvention.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the various embodiments of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

The present invention generally provides methods and devices forcontrolling movement of a working end of a surgical device and, inparticular, for performing various surgical procedures using aninstrument having an end effector that can be articulated relative to anelongate shaft of the device by means of flexible or semi-flexibleactuation members such as, for example, wires. As will described infurther detail below, various embodiments are provided with a unique andnovel coupling arrangement that permits the end effector to be rotatedwithout adversely affecting the actuation wire or wires. Articulationand rotation of the end effector will allow the end effector to bepositioned at various locations during a surgical procedure, therebyproviding the user with precise control over the end effector. A personskilled in the art will appreciate that the present invention hasapplication in endoscopic procedures, laparoscopic procedures, and inconventional open surgical procedures, including robotic-assistedsurgery.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a clinician manipulating the handle portion ofthe surgical instrument. The term “proximal” referring to the portionclosest to the clinician and the term “distal” referring to the portionlocated away from the clinician. It will be further appreciated that,for convenience and clarity, spatial terms such as “vertical”,“horizontal”, “up” and “down” may be used herein with respect to thedrawings. However, surgical instruments are used in many orientationsand positions, and these terms are not intended to be limiting and/orabsolute.

FIGS. 1 and 2 illustrate one exemplary embodiment of an insertionportion 10 of a manually articulatable surgical device. The insertionportion 10 is preferably configured to be inserted into a patient'sbody, and it can be rigid for laparoscopic applications, flexible forendoscopic applications, or it can have rigid and flexible portions asmay be desired. As shown, the insertion portion 10 may include asubstantially hollow elongate shaft 12 that has a working end or endeffector 14 coupled to a distal end 12 b thereof by a three-bar linkage16. See FIG. 2. While the end effector 14 can have variousconfigurations, as will be discussed in more detail below, in theillustrated embodiment the end effector 14 is in the form of a grasperhaving “actuation features” such as, for example, opposed jaws 18 a, 18b that are pivotally coupled to one another. As used herein, the term“actuation features” refers to movable or otherwise actuatablemember(s), device(s), instrument(s), portion(s) of the end effector thatare manipulatable or otherwise perform a desired function uponapplication of one or more actuation motions thereto. Such actuationfeatures may include, but are not limited to, grasper jaws, biopsyforceps, tissue-penetrating spikes, snare loops, scissors, needleknives, sphincterotomes, etc. As the present Detailed Descriptionproceeds, the person of ordinary skill in the art will readilyappreciate that the various embodiments of the present invention may beeffectively and advantageously employed with a variety of different endeffector configurations. Accordingly, the protection afforded to thevarious embodiments of the present invention should not be limited to aspecific end effector that employs a specific actuation feature.

The three-bar linkage 16 allows the end effector 14 to be oriented at anangle relative to a longitudinal axis L-L of the elongate shaft 12. Thedevice can also optionally be configured to allow the end effector 14 torotate relative to and about the longitudinal axis L-L of the elongateshaft 12. In the illustrated embodiment, the three-bar linkage 16 isrotatably coupled to the distal end 12 b of the elongate shaft 12, andthus the three-bar linkage 16, as well as the end effector 14 coupledthereto, can be positioned in various axial orientations. The locationof the rotation joint R proximal of the articulation joint A isparticularly advantageous in that rotation of the end effector 14 canchange the location of the plane within which the end effector 14articulates.

The three-bar linkage 16 can have a variety of configurations, but in anexemplary embodiment, as shown in more detail in FIG. 2, it includesthree links 20, 22, 24 that are movably coupled to one another. Eachlink can have a variety of configurations, but in an exemplaryembodiment, the first and second links 20, 22 each have a generallyhollow elongate shape and the third link 24 is in the form of anelongate rod or bar. The first link 20 can have a proximal end 20 a thatis coupled to a distal end 12 b of the elongate shaft 12 via first andsecond rotation couplings 26 and 28 which will be discussed in moredetail below. The distal end 20 b of the first link 20 can be movablycoupled to a proximal end 22 a of the second link 22, e.g., by a pivotjoint. The distal end 22 b of the second link 22 can in turn be coupledto the end effector 14 for manipulation thereof by the three-bar linkage16. The third link 24 can extend at least partially through the firstand second links 20, 22, and it can have a distal end 24 b that ispivotally coupled to the second link 22, e.g., by a pivot pin, to formthe three-bar linkage 16. The particular location at which the thirdlink 24 mates to the second link 22 can vary, but it is preferablypivotally mated at a location that will allow the third link 24 to applya force to the second link 22 to cause the second link 22 to articulaterelative to the first link 20. The proximal end of the third link 24 canbe coupled to an articulation coupling 34 that is coupled to anarticulation actuator 30 that extends through the elongate shaft 12 andat least partially through the first link 20.

The articulation actuator 30 can have a variety of configurations, butin an exemplary embodiment, the articulation actuator 30 comprises a“semi-flexible” member or wire fabricated from, for example, stainlesssteel, Nickel-Titanium alloy (Nitinol®), etc. As used herein, the term“semi-flexible” means components that are able to exhibit adequateflexibility within the desired strain with pit permanent deformation yetdeliver acceptable stiffness for the desired load transmission. As canbe seen in FIG. 2, articulation coupling 34 may comprise a tubularmember that is attached to the articulation actuator 30 and is pivotallyattached to the third link 24. In various embodiments, for example, thearticulation actuator 30 may be attached to the articulation coupling 34by, for example, welding, gluing, swaging, coining, crimping, etc.

In use, proximal movement of the articulation actuator 30 relative toand along the longitudinal axis L-L of the elongate shaft 12 will applya proximally-directed force to the third link 24. The third link 24 willthus apply a proximally-directed force to the second link 22, causingthe second link 22 to pivot laterally relative to the longitudinal axisL-L of the elongate shaft 12. As a result, the second link 22, with theend effector 14 coupled thereto, will move laterally in a single planeto allow the end effector 14 to extend at an angle relative thelongitudinal axis L-L of the elongate shaft 12, as shown in FIG. 2. Theend effector 14 can be returned to the original, longitudinally-alignedposition, shown in FIG. 1 by moving the articulation actuator 30distally relative to the elongate shaft 12.

As previously indicated, in addition to articulating movement, the endeffector 14 can also be configured to rotate relative to the elongateshaft 12, thus allowing the end effector 14 to be positioned in multipleangular orientations. The particular location of the rotation joint Rcan vary, and it can be located proximal to the three-bar linkage 16, ata mid-portion of the three-bar linkage 16, or distal to the three-barlinkage 16. In an exemplary embodiment, the rotation joint R is locatedproximal to the three-bar linkage 16, and more preferably proximal tothe articulation joint A formed between the first and second links 20,22. As shown in FIGS. 2 and 2A, the first link 20 can be rotatablycoupled to the distal end 12 b of the elongate shaft 12 by one or morerotation couplings.

The illustrated embodiment includes first and second rotation couplings26, 28. Second rotation coupling 28 may be affixed to (e.g., welded,glued, etc.) to a coupling sleeve 490. The first rotation coupling 26has a generally elongate hollow shape with a proximal end 26 a that isfixedly mated to the elongate shaft 12 and a distal end 26 b that hasdeflectable tabs 26 c formed therearound. The tabs 26 c can be formed bylongitudinally-extending cut-outs formed in and spaced radially aroundthe distal end 26 b of the first rotation coupling 26. Each tab 26 c caninclude an annular flange or lip formed on an inner surface thereof. Thesecond rotation coupling 28 can be rotatably supported on the couplingsleeve 490 by advancing the tabs 26 c over a retention flange 492 on thecoupling sleeve 490. The tabs 26 c will deflect until the annular flangeor lip on the tabs 26 c extends into and engages a groove 494 formed inthe coupling sleeve 490. The elongate shaft 12 may be affixed to thefirst rotation coupling 26 by welding, adhesive, etc. Such arrangementpermits the first rotation coupling 26 and the elongate shaft 12 torotate about the coupling sleeve 490.

As can also be seen in FIGS. 2 and 2A, the proximal end 20 a of the offirst link 20 extends onto the distal end 28 b of the second rotationcoupling 28, to enable the first link 20 to rotate relative thereto.Rotation of articulation actuator 30 relative to and about thelongitudinal axis L-L of the elongate shaft 12 will rotate thearticulation coupling 34 and the third link 24, which is coupled to thesecond link 22, which in turn is coupled to the end effector 14 and thefirst link 20. As a result, the entire three-bar linkage 16 will rotatewith the end effector 14 relative to and about the longitudinal axis L-Lof the elongate shaft 12. Rotation can also be done while the endeffector 14 is articulated, thereby changing the plane within which theend effector 14 articulates.

Various embodiments of the subject invention may further include a thirdrotation coupling 500. The third rotation coupling 500 may include adriving coupler 510 that is axially and rotatably movable within theelongate shaft 12 and a portion of the coupling sleeve 490. An idlercoupler 520 may be rotatably coupled to a distal end 510 a of thedriving coupler 510 in the manner depicted in FIGS. 2 and 2A such thatthe driving coupler 510 and the idler coupler 520 may rotate relative toeach other, yet move axially as a unit within the elongate shaft 12. Thedriving coupler 510 has an axial hole 512 extending therethrough throughwhich a portion of the articulation actuator 30 movably and rotationallyextends. Likewise, the idler coupler 520 has an axial hole 522 throughwhich a portion of the articulation actuator 30 movably and rotationallyextends. Thus, actuation of the articulation actuator 30 is not impededby the coupling 500.

Also in various embodiments, a “first” input actuator 530 is attached tothe driving coupler 510. The input actuator 530 may comprise, forexample, a “semi-flexible” member or wire that may be manufactured fromstainless steel, Nickel-Titanium alloy (Nitinol®), etc. Likewise, anoutput actuator 540 that may comprise, for example, a “semi-flexible”member or wire that may be manufactured from stainless steel,Nickel-Titanium alloy (Nitinol®), etc. is attached to the idler coupler520 and an actuation pusher 44 in the end effector 14.

As indicated above, the end effector 14 of the device can have variousconfigurations but in the embodiment shown in FIGS. 1 and 2, the endeffector 14 is in the form of a grasper having opposed jaws 18 a, 18 b.Jaw 18 a includes a distal portion 36 b that may have a series of teeth37 formed thereon for grasping tissue, and a proximal portion 36 a, thatpivotally mates to an actuation link 40. See FIG. 1. Jaw 18 b includes adistal portion 38 b that may have a series of teeth 39 formed thereonfor grasping tissue, and a proximal portion 38 a that pivotally mates toan actuation link 42. The jaws 18 a, 18 b may be pivotally mated to oneanother at a pivot point P located between the proximal and distalportions 36 a, 38 a, 36 b, 38 b. The proximal end of each actuation link40, 42 may be pivotally mated to an actuation pusher 44 that may beslidably disposed within and between opposed slots formed in a distalportion of the second link 22. Such a configuration will preventindependent rotation of the actuation pusher 44 relative to the secondlink 22. As can also be seen in FIG. 2, the distal end 24 b of thesecond link 24 is pivotally coupled to (pinned) to the link 22.

In use, proximal movement of the input actuator 530 relative to theelongate shaft 12 will pull the driving coupler 510 and idler coupler520 in the proximal direction “PD” within the coupling sleeve 490.Movement of the idler coupler 520 in the proximal direction “PD” alsocauses the actuation pusher 44 to move within the slots formed in thesecond link 22. The actuation links 40, 42 will thus be pulled in theproximal direction “PD”, bringing the proximal and distal portions 36 a,38 a, 36 b, 38 b of each jaw 18 a, 18 b toward each other to therebyclose the jaws 18 a, 18 b. Conversely, distal movement of the inputactuator 530 causes the driving coupler 510 and idler coupler 520 tomove distally and cause the actuation pusher 44 to also move distallywithin the slots formed in the second link 22. Such movement will causethe links 40, 42 and the proximal and distal portions 36 a, 38 a, 36 b,38 b of the jaws 18 a, 18 b to pivot laterally outward, thereby openingthe jaws 18 a, 18 b.

As previously indicated, the device can also include a handle assembly50 coupled to the proximal end of the elongate shaft 12 and have variouscontrols formed thereon for controlling and manipulating the device. Aperson skilled in the art will appreciate that the particularconfiguration of the handle can vary, and that various techniques knownin the art can be used for effecting movement of various portions on thedevice. FIGS. 3-5 illustrate one exemplary embodiment of a handle 50 foruse with the insertion portion 10 of the device shown in FIGS. 1 and 2.As shown, the handle 50 has a generally elongate cylindricalconfiguration to facilitate grasping thereof. The handle housing 52 canhave an integral or unitary configuration, or it can be formed from twohousing halves 52 a, 52 b that mate together to enclose variouscomponents therein. The housing halves 52 a, 52 b are shown in FIG. 4and may be removably attached together by bolts 53 and nuts 55. Thevarious components disposed within the handle housing 52 can also vary,but in an exemplary embodiment, the handle assembly 50 includes anarticulation knob 54 for articulating and rotating the end effector 14,and an actuation knob 56 for actuating the end effector 14.

The articulation knob 54 may have a generally cylindrical configuration.The knob 54 can have an integral or unitary configuration, or it can beformed from two halves 54 a, 54 b that may be coupled together by bolts57 and nuts 59, as shown. While various techniques can be used to affixthe articulation actuator 30 to the articulation knob 54, in anexemplary embodiment the articulation knob 54 includes an axle 58fixedly disposed therein and engaged between the knob halves 54 a, 54 b.The articulation actuator 30 extends through an inner lumen of the axle58 and is affixed thereto. Various fastening techniques can be used toaffix the articulation actuator 30 to the axle 58 including, forexample, an interference or compression fit, an adhesive, or othermechanical or chemical mating techniques known in the art. The proximalend 30 a of the articulation actuator 30 can mate to the knob 54 suchthat rotation and translation of the knob 54 will cause correspondingrotation and translation of the articulation actuator 30, therebyrotating and articulating the end effector 14, as previously described.

In various embodiments, the handle housing 52 can include an elongatecavity 52 c formed therein that is configured to slidably and rotatablyreceive a portion of the knob 54 therein. The handle housing 52 can alsoinclude one or more cut-outs 60 formed therein for allowing a user toaccess the knob. FIG. 3 illustrates opposed cut-outs 52 d, 52 e formedin the handle housing 52. The articulation knob 54 can also includefeatures to facilitate movement thereof. For example, the articulationknob 54 can include one or more surface features formed on an externalsurface thereof for allowing the user to more easily grasp the knob. Inthe illustrated embodiment, the knob 54 includes a series oflongitudinally-oriented teeth 54 t formed on a portion thereof. Invarious embodiments, the articulation knob 54 may have two axiallyspaced annular grooves 62 and 64 formed therein as shown. In particular,when the articulation knob 54 has been moved to its distal-mostposition, the annular groove 62 is positioned to selectively receive alocking screw 70 therein. Likewise, when the articulation knob 54 is inits proximal-most position, the annular groove 64 is positioned toselectively receive the locking screw 70 therein. Thus, by use of thelocking screw 70, the surgeon may lock the device in a desiredarticulated position.

In use, the articulation knob 54 can be grasped by a user and rotatedabout its longitudinal axis (i.e., about the longitudinal axis L-L ofthe shaft 12 and handle 50). Rotation of the knob 54 will causecorresponding rotation of the axle 58 and the articulation actuator 30.The articulation actuator 30 is not coupled to the articulation knob 54and therefore is not affected by its actuation. As previously explained,rotation of the articulation actuator 30 will cause correspondingrotation of the three-bar linkage 16 and the end effector 14. Thearticulation knob 54 can also be moved or translated longitudinallyalong the longitudinal axis L-L, and within the elongate cavity 52 cformed in the handle housing 52. Proximal movement of the articulationknob 54 within the handle housing 52 will pull the articulation actuator30 in the proximal direction “PD”, thereby articulating the end effector14, as previously explained. Distal movement of the articulation knob 54within the handle housing 52 will in turn move the articulation actuator30 distally, thereby returning the end effector 14 to its originallongitudinally-aligned position.

As indicated above, the device can also include an actuation knob 56 foractuating the actuation features on the end effector 14 (i.e. forfiring, opening and closing, energizing, etc.). The actuation knob 56can have a variety of configurations, but in the illustrated embodimentthe knob 56 has a bar-bell shape. The knob 56 can have an integral orunitary configuration, or it can be formed from two halves 56 a, 56 bthat mate together, as shown in FIG. 4. The proximal end 530 a of theinput actuator 530 can be affixed to the actuation knob 56 such thattranslation of the knob 56 will cause corresponding translation of theinput actuator 530, thereby actuating the end effector 14 as previouslydescribed. In the illustrated embodiment, the proximal end 530 a of theinput actuator 530 may have a bend 532 formed therein for mating withthe actuation knob 56 as described, for example, in U.S. PatentPublication No. U.S. 2008/0147113A1, which has been herein incorporatedby reference in its entirety. The proximal end 530 a may be slidablysupported within a support member 534 that is slidably received within aslot 538 formed in a shaft portion 62 of the handle 60. The inputactuator 530 also passes through the axle 58 such that it may axiallyslide therein and axle 58 may be freely rotated therearound.

Actuation knob 56 is slidably disposed around an elongate shaft portion62 of the handle housing 52. In use, the knob 56 can be grasped by auser and translated along the shaft portion 62 of the handle housing 52.Proximal movement of the actuation knob 56 along the shaft portion 62will pull the input actuator 530 proximally, thereby opening the jaws 18a, 18 b of the end effector 12 as previously explained. Distal movementof the actuation knob 56 along the shaft portion 62 will in turn movethe input actuator 530 distally, thereby moving the jaws 18 a, 18 b tothe closed position. Those of ordinary skill in the art will appreciatethat the unique and novel third rotational coupler 500 of the presentinvention enables the actuators 30, 530, 540 to be independentlyoperated while avoiding aberrant twisting/jamming of the actuators whenthe end effector is to be articulated, rotated and/or actuated.

Another rotational coupler embodiment 600 of the present invention isdepicted in FIG. 7. As can be seen in that Figure, the rotationalcoupler 600 may include a coupler housing 610 that is supported in anouter sheath 620 which is supported in the hollow elongate shaft 12. Thecoupling housing 610 may be fabricated from, for example, stainlesssteel, etc. and be provided in two mating pieces that may be coupledtogether by welding, gluing, swaging, coining, crimping, etc. The outersheath 620 may be fabricated from, for example, stainless steel, etc. Invarious embodiments, the coupling housing 610 has a centrally disposedcylindrical opening 612 formed therein and an axial passage 614extending therethrough. A proximal tubular member 630 that has a flangedend 632 is mounted within the coupling housing 610 as shown. Likewise, adistal tubular member 640 that has a flanged end 642 is also mountedwithin the coupling housing 610 as shown. Tubular members 630, 640 maybe fabricated from, for example, stainless steel, etc. Tubular members630, 640 are sized to axially rotate about axis L-L relative to thecoupling housing 610 as will be discussed in further detail below.

As can be further seen in FIG. 7, the proximal tubular member 630 has anaxial passage 634 therethrough and the distal tubular member 640 has apassage 644 therethrough. When mounted within the coupling housing 610,the passages 634 and 644 are coaxially aligned to form a passage 650through the coupler for operably receiving an actuator member 570therethrough such that the actuation member 570 can freely move axiallyand rotate within the passage 650. The actuation member 570 maycomprise, for example, stainless steel, Nickel-Titanium alloy(Nitinol®), etc. The device may have a handle member of the typedescribed above such that the proximal end of the actuation member 570is coupled to the actuation knob 56 in the manners described above. Thedistal end 570 b of the actuation member 570 may be coupled to theactuation pusher 44 in the above-described manner. In use, proximalmovement of the actuation member 570 relative to the elongate shaft 12will pull the actuation pusher 44 in the proximal direction “PD” withinthe slots formed in the second link 22. The actuation links 40, 42 willthus be pulled proximally “PD”, bringing the proximal and distalportions 36 a, 38 a, 36 b, 38 b of each jaw 18 a, 18 b toward each otherto thereby close the jaws 18 a, 18 b. Conversely, distal movement of theactuation member 570 causes the actuation pusher 44 to also movedistally within the slots formed in the second link 22, which will causethe links 40, 42 and the proximal and distal portions 36 a, 38 a, 36 b,38 b of the jaws 18 a, 18 b to pivot laterally outward, thereby openingthe jaws 18 a, 18 b.

Also in various embodiments, an input articulation member 730 isnon-movably affixed to the proximal end of the proximal tubular member630. The input articulation member 730 may comprise, for example,stainless steel, Nickel-Titanium alloy (Nitinol®), etc. and benon-movably affixed to the proximal tubular member 630 by, for example,welding, gluing, swaging, coining, crimping, etc. The proximal end ofthe input articulation member 730 may be coupled to the articulationknob 54 in the manners described above. Thus, the input articulationmember 730 may be axially and rotatably moved within the elongate shaft12 by manipulation of the articulation knob 54.

Also in various embodiments, an output articulation member 740 isnon-movably attached to the distal tubular member 640 and thearticulation coupling 34. The output articulation member 740 maycomprise, for example, stainless steel, Nickel-Titanium alloy(Nitinol®), etc. and be attached to the distal tubular member 640 by,for example, welding, gluing, swaging, coining, crimping, etc. In use,movement of the input articulation member 730 in the proximal direction“PD” relative to and along the longitudinal axis L-L of the elongateshaft 12 will pull the proximal tubular member 630 as well as the entirerotational coupler 600 in the proximal direction “PD” and will apply aproximally-directed force to the third link 24. The third link 24 willthus apply a proximally-directed force to the second link 22, causingthe second link 22 to pivot laterally relative to the longitudinal axisL-L of the elongate shaft 12. As a result, the second link 22, with theend effector 14 coupled thereto, will move laterally in a single planeto allow the end effector 14 to extend at an angle relative thelongitudinal axis L-L of the elongate shaft 12. The end effector 14 canbe returned to the original, longitudinally-aligned position, shown inFIG. 1 by moving the input articulation member 730 distally relative tothe elongate shaft 12.

Rotation of input articulation member 730 relative to and about thelongitudinal axis L-L of the elongate shaft 12 will rotate thearticulation coupling 34 and the third link 24, which is coupled to thesecond link 22, which in turn is coupled to the end effector 14 and thefirst link 20. As a result, the entire three-bar linkage 16 will rotatewith the end effector 14 relative to and about the longitudinal axis L-Lof the elongate shaft 12. Rotation can also be accomplished while theend effector 14 is articulated, thereby changing the plane within whichthe end effector 14 articulates. Again such unique and novel rotationalcoupler arrangement enable the actuators 30, 530, 540 to beindependently operated while avoiding aberrant twisting/jamming of theactuators when the end effector is to be articulated, rotated and/oractuated.

While the rotational couplers discussed above are described and shown inconnection with an end effector that employs actuation features such asgrasper jaws, the various coupler embodiments of the present inventionmay be effectively employed in connection with a variety of other endeffectors for performing various surgical procedures. Examples of suchend effector arrangements may comprise those end effector arrangementsdescribed in U.S. Patent Application Publication No. U.S. 2008/0147113,such as, for example, biopsy forceps, tissue-penetrating spikes, snareloops, scissors, needle knives and sphincterotomes. A person skilled inthe art will appreciate that the rotation coupler embodiments of thepresent invention may be used in connection with a variety of other endeffectors other than those described and illustrated herein and in theaforementioned published application which has been herein incorporatedby reference in its entirety.

As indicated above, the various devices disclosed herein for controllingmovement of a working end of a surgical device can be used in a varietyof surgical procedures, including endoscopic procedures, laparoscopicprocedures, and in conventional open surgical procedures, includingrobotic-assisted surgery. In one exemplary endoscopic procedure, anelongate shaft of a surgical device, such as one previously disclosedherein, can be inserted through a natural orifice and a body lumen toposition an end effector located at a distal end of the elongate shaftadjacent to tissue to be treated. An articulation actuator can betranslated along a longitudinal axis of the elongate shaft to cause athree-bar linkage to laterally articulate the end effector in adirection substantially perpendicular to a longitudinal axis of theelongate shaft to allow the end effector to be angularly orientedrelative to the elongate shaft. This can be achieved by actuating one ormore actuation mechanisms formed on a handle of the device. The methodcan also include rotating the end effector relative to the elongateshaft. In one embodiment, the three-bar linkage can rotate with the endeffector relative to the elongate shaft. For example, the articulationactuator can be rotated relative to the elongate shaft to rotate boththe three-bar linkage and the end effector. In another embodiment, theend effector can rotate relative to the three-bar linkage. For example,an actuation wire coupled to the end effector and extending through theelongate shaft and the three-bar linkage can be rotated.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

The invention which is intended to be protected is not to be construedas limited to the particular embodiments disclosed. The embodiments aretherefore to be regarded as illustrative rather than restrictive.Variations and changes may be made by others without departing from thespirit of the present invention. Accordingly, it is expressly intendedthat all such equivalents, variations and changes which fall within thespirit and scope of the present invention as defined in the claims beembraced thereby.

What is claimed is:
 1. A rotational coupling for a surgical device thatis movably coupled to an elongate shaft, wherein said rotationalcoupling comprises: a first actuator, wherein the surgical device has atleast one actuation feature thereon that is actuatable upon applicationof at least one first actuation motion from the first actuator; a secondactuator, wherein the surgical device is movable relative to theelongate shaft upon application of at least one second actuation motionfrom the second actuator; a driver member coupled to the first actuatorfor receiving the at least one first actuation motion therefrom; anidler member rotatably coupled to said driver member for selectiverotation relative to said driver member about a longitudinal axis andconfigured to axially move as a unit with said driver member relative tothe elongate shaft in response to the at least one first actuationmotion, said driver member and said idler member movably supporting aportion of the second actuator therein; and an output member coupled tosaid idler member and the surgical device for transferring the at leastone first actuation motion from said idler member to the surgicaldevice, wherein said output member is configured to move axially as asingle unit with said idler member relative to said second actuator inresponse to the at least one first actuation motion, and wherein adistal end portion of said driver member and a proximal end portion ofsaid idler member are rotatably coupled together by a coupler housingthat is movably supported within the elongate shaft coupled to thesurgical device.
 2. The rotational coupling of claim 1 wherein the atleast one first actuation motion applied by the first actuator is atleast one axial motion and the at least one second actuation motionapplied by the second actuator comprises at least one of axial motionsand rotation motions.
 3. The rotational coupling of claim 1 wherein thesurgical device is articulatable relative to the elongate shaft uponapplication of the at least one second actuation motion.
 4. Therotational coupling of claim 1 wherein the surgical device is rotatablerelative to the elongate shaft upon application of the at least onesecond actuation motion.
 5. A rotational coupling for a surgical devicethat is movably coupled to an elongate shaft, wherein said rotationalcoupling comprises: a first actuator, wherein the surgical device has atleast one actuation feature thereon that is actuatable upon applicationof at least one first actuation motion from the first actuator; a secondactuator, wherein the surgical device is movable relative to theelongate shaft upon application of at least one second actuation motionfrom the second actuator; a driver member coupled to the first actuatorfor receiving the at least one first actuation motion therefrom; anidler member rotatably coupled to said driver member for selectiverotation relative to said driver member about a longitudinal axis andconfigured to axially move as a unit with said driver member relative tothe elongate shaft in response to the at least one first actuationmotion, said driver member and said idler member movably supporting aportion of the second actuator therein; and an output member coupled tosaid idler member and the surgical device for transferring the at leastone first actuation motion from said idler member to the surgicaldevice, wherein said output member is configured to move axially as asingle unit with said idler member relative to said second actuator inresponse to the at least one first actuation motion, and wherein thefirst actuator comprises a semi-flexible wire, wherein the secondactuator comprises a semi-flexible wire, and wherein said output membercomprises a semi-flexible wire.
 6. A rotational coupling for a surgicaldevice that is movably coupled to an elongate shaft, wherein saidrotational coupling comprises: a first actuator, wherein the surgicaldevice has at least one actuation feature thereon that is actuatableupon application of at least one first actuation motion from the firstactuator; a second actuator, wherein the surgical device is movablerelative to the elongate shaft upon application of at least one secondactuation motion from the second actuator; a driver member coupled tothe first actuator for receiving the at least one first actuation motiontherefrom; an idler member rotatably coupled to said driver member forselective rotation relative to said driver member about a longitudinalaxis and configured to axially move as a unit with said driver memberrelative to the elongate shaft in response to the at least one firstactuation motion, said driver member and said idler member movablysupporting a portion of the second actuator therein; and an outputmember coupled to said idler member and the surgical device fortransferring the at least one first actuation motion from said idlermember to the surgical device, wherein said output member is configuredto move axially as a single unit with said idler member relative to saidsecond actuator in response to the at least one first actuation motion,and wherein said driver member comprises a proximal tubular memberincluding a proximal axial passage extending therethrough and whereinsaid idler member comprises a distal tubular member including a distalaxial passage therethrough.
 7. The rotational coupling of claim 6wherein a distal end of said proximal tubular member is movablysupported in a coupler housing and wherein a proximal end of said distaltubular member is movably supported in said coupler housing such thatsaid distal axial passage in said distal tubular member is substantiallycoaxially aligned with said proximal axial passage in said proximaltubular member to form a passageway through said rotational coupling tomovably support an articulation actuator therethrough.
 8. The rotationalcoupling of claim 7 wherein said passageway is configured to permit saidarticulation actuator to move axially and rotatably therethrough.
 9. Arotational coupling assembly for a surgical instrument, wherein thesurgical instrument includes an end effector that is movably coupled toan elongate shaft, and wherein said rotational coupling assemblycomprises: a first actuator configured to transmit at least one firstactuation motion, wherein the end effector includes at least oneactuation feature thereon that is actuatable upon application of the atleast one first actuation motion; a second actuator configured totransmit at least one second actuation motion, wherein the end effectoris movable relative to the elongate shaft upon application of the atleast one second actuation motion; a driver member coupled to the firstactuator for receiving the at least one first actuation motiontherefrom; an idler member rotatably coupled to said driver member forselective rotation relative to said driver member about a longitudinalaxis, wherein said idler member is configured to axially move as a unitwith said driver member relative to the elongate shaft in response tosaid at least one first actuation motion, wherein said driver member andsaid idler member movably support a portion of said second actuator; andan output member configured to couple said idler member to the endeffector for transferring said at least one first actuation motion fromsaid idler member to the end effector, wherein said output member isconfigured to move axially as a single unit with said idler memberrelative to said second actuator in response to the at least one firstactuation motion, and wherein a distal end portion of said driver memberand a proximal end portion of said idler member are rotatably coupledtogether by a coupler housing that is movably supported within theelongate shaft coupled to the surgical device.
 10. A rotational couplingfor a surgical device that is movably coupled to an elongate shaft,wherein said rotational coupling comprises: a first actuator, whereinthe surgical device has at least one actuation feature thereon that isactuatable upon application of at least one first actuation motion fromthe first actuator; a second actuator, wherein the surgical device ismovable relative to the elongate shaft upon application of at least onesecond actuation motion from the second actuator; a driver membercoupled to the first actuator for receiving the at least one firstactuation motion therefrom; an idler member rotatably coupled to saiddriver member for selective rotation relative to said driver memberabout a longitudinal axis and configured to axially move as a unit withsaid driver member relative to the elongate shaft in response to the atleast one first actuation motion, said driver member and said idlermember movably supporting a portion of the second actuator therein; andan output member coupled to said idler member and the surgical devicefor transferring the at least one first actuation motion from said idlermember to the surgical device, wherein said output member is configuredto move axially as a single unit with said idler member relative to saidsecond actuator in response to the at least one first actuation motion,wherein said output member extends distally from said idler member,wherein said idler member extends distally from said driver member, andwherein said first actuator extends proximally from said driver member.11. The rotational coupling of claim 10 wherein the first actuatorcomprises a semi-flexible wire, wherein the second actuator comprises asemi-flexible wire, and wherein said output member comprises asemi-flexible wire.
 12. The rotational coupling of claim 10 wherein adistal end portion of said driver member and a proximal end portion ofsaid idler member are rotatably coupled together by a coupler housingthat is movably supported within the elongate shaft coupled to thesurgical device.
 13. The rotational coupling of claim 10 wherein the atleast one first actuation motion applied by the first actuator is atleast one axial motion and the at least one second actuation motionapplied by the second actuator comprises at least one of axial motionsand rotation motions.
 14. The rotational coupling of claim 10 whereinsaid driver member comprises a proximal tubular member including aproximal axial passage extending therethrough and wherein said idlermember comprises a distal tubular member including a distal axialpassage therethrough.
 15. The rotational coupling of claim 14 wherein adistal end of said proximal tubular member is movably supported in acoupler housing and wherein a proximal end of said distal tubular memberis movably supported in said coupler housing such that said distal axialpassage in said distal tubular member is substantially coaxially alignedwith said proximal axial passage in said proximal tubular member to forma passageway through said rotational coupling to movably support anarticulation actuator therethrough.
 16. The rotational coupling of claim15 wherein said passageway is configured to permit said articulationactuator to move axially and rotatably therethrough.
 17. The rotationalcoupling of claim 10 wherein the surgical device is articulatablerelative to the elongate shaft upon application of the at least onesecond actuation motion.
 18. The rotational coupling of claim 10 whereinthe surgical device is rotatable relative to the elongate shaft uponapplication of the at least one second actuation motion.